When brought to light by the legendary Navratilova this week, the BBC responded with a series of "differences" between the two commentators roles: McEnroe has more hours and days on air, being on call for BBC, a larger contractual commitment to BBC -- all of which, of course, are controlled by BBC.

This seemingly unforced error hit close to home for us in cardiology, as we have seen recent data of persistent gender gaps in compensation. And we are not alone, as this is evident in the profession of nursing as well.

Cardiology

Last year, we were made aware by a study in the Journal of the American College of Cardiology that women cardiologists do "different" work and make less money than men. When corrected for the differences in job description, the under-compensation remained glaring, averaging about $1,000,000 over their careers.

Indeed, women in cardiology are more likely to specialize in the lower paying subspecialties of general (including preventive) and noninvasive cardiology (53% versus 28%). And a much lower proportion of women cardiologists were found to be doing interventional or electrophysiology compared with men (11% versus 39%).

Fewer women in cardiology have full-time positions (80% versus 91%), and they generate fewer relative value units (RVUs). But when corrected for job description, seniority, on call time and hours or RVUs, the nearly $32,000 annual compensation difference remains unexplained.

Historically, the field of nursing was predominantly female. Some nurses have experienced a form of harassment due to a paternalistic medical system where orders were given to nurses, as opposed to a collaborative team relationship. The introduction of male nurses has brought a positive change to a field that requires strong, caring clinicians of either sex.

However, there are reports of a gross discrepancy in pay between men and women in this field, particularly acute in female nurse anesthetists making $17,290 less annually than their male counterparts. Similarly, a recent survey showed that male nurse practitioners earned $12,859 more than their female counterparts after adjusting for differences in demographics and work characteristics.

There should be very little difference in roles other than years of experience and advancements in leadership. It is astounding that nurses of the same level should be paid so differently, and concerns remain that female nurses still bear the brunt of sexist behavior even today.

Serving Some Solutions

Equity in salary may be just one of many challenges medical systems are forced to address while trying to stay afloat in challenging financial times. Current systems often reward certain aspects of a candidate's subjective "value." But without transparent guidelines or rules to assure equity, this is hard to achieve. To move the field forward, a more open, systems-based approach with meaningful change is required to achieve equity in the current environment.

Some potential approaches include:

Equal base pay based on objective criteria of rank and time in rank (or equivalent in practice settings)

Additional salary may be earned through clinical, academic, or administrative work based on a transparent and uniformly-applied series of metrics appropriate to each institution's mission and goals

Bonuses may be earned through exceptional work in any mission area but need to be clearly tied to objective, measurable achievements and be substantial enough to influence desired behavior

All clinicians or faculty should have equal access to "high value" work

The implementation of "compensation boards" within institutions (academic or otherwise) to review salary and bonus amounts, or salary audits, could similarly assure that salaries and promotions are equitable and leadership opportunities are fairly allocated

Knowing that compensation discrepancies and differential access to leadership opportunities transcend multiple disciplines (finance, film, music, sports, healthcare) perhaps we need to actively lobby Congress for enforcement of the Equal Pay Act of 1963. The male-female salary gap has narrowed in many occupations over the past 55 years, but persists for many, including medicine and nursing.

Every leader with financial decision-making responsibility should know these data and push for correction. The ball is in your court.

Eugenia Gianos, MD, is Associate Professor in the Department of Medicine and Co-Clinical Director of the Center for Prevention of Cardiovascular Disease at New York University in New York City.

Lynne T. Braun, PhD, CNP, is Professor in the Department of Adult and Gerontological Nursing Professor and Department of Internal Medicine, Division of Cardiology, at Rush University Medical Center in Chicago.

Pamela S. Douglas, MD, is the Ursula Geller Professor of Research in Cardiovascular Disease at Duke University School of Medicine in Durham, North Carolina.

Kim Allan Williams Sr., MD, is the James B. Herrick Professor and Chief of the Division of Cardiology at Rush University Medical Center.

Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.